title: Acute and critically ill peripartum cardiomyopathy and 'bridge to' therapeutic options: a single center experience with intra-aortic balloon pump, extra corporeal membrane oxygenation and continuous-flow left ventricular assist devices.
abstract: BACKGROUND
  Peripartum cardiomyopathy (PPCM) patients refractory to medical therapy and intra-aortic balloon pump (IABP) counterpulsation or in whom weaning from these therapies is impossible, are candidates for a left ventricular assist device (LVAD) as a bridge to recovery or transplant. Continuous-flow LVADs are smaller, have a better long-term durability and are associated with better outcomes. Extra corporeal membrane oxygenation (ECMO) can be used as a temporary support in patients with refractory cardiogenic shock. The aim of this study was to evaluate the efficacy and safety of mechanical support in acute and critically ill PPCM patients.
  
  
  METHODS
  This was a retrospective search of the patient database of the Ghent University hospital (2000 to 2010).
  
  
  RESULTS
  Six PPCM-patients were treated with mechanical support. Three patients presented in the postpartum period and three patients at the end of pregnancy. All were treated with IABP, the duration of IABP support ranged from 1 to 13 days. An ECMO was inserted in one patient who presented with cardiogenic shock, multiple organ dysfunction syndrome and a stillborn baby. Two patients showed partial recovery and could be weaned off the IABP. Four patients were implanted with a continuous-flow LVAD (HeartMate II, Thoratec Inc.), including the ECMO-patient. Three LVAD patients were successfully transplanted 78, 126 and 360 days after LVAD implant; one patient is still on the transplant waiting list. We observed one peripheral thrombotic complication due to IABP and five early bleeding complications in three LVAD patients. One patient died suddenly two years after transplantation.
  
  
  CONCLUSIONS
  In PPCM with refractory heart failure IABP was safe and efficient as a bridge to recovery or as a bridge to LVAD. ECMO provided temporary support as a bridge to LVAD, while the newer continuous-flow LVADs offered a safe bridge to transplant.
authors.affiliation: Department of Cardiology, Heart Center, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. sofie.gevaert@ugent.be
authors.forename: Sofie
authors.initials: S
authors.lastname: Gevaert
authors.forename: Yves
authors.initials: Y
authors.lastname: Van Belleghem
authors.forename: Stefaan
authors.initials: S
authors.lastname: Bouchez
authors.forename: Ingrid
authors.initials: I
authors.lastname: Herck
authors.forename: Filip
authors.initials: F
authors.lastname: De Somer
authors.forename: Yasmina
authors.initials: Y
authors.lastname: De Block
authors.forename: Fiona
authors.initials: F
authors.lastname: Tromp
authors.forename: Els
authors.initials: E
authors.lastname: Vandecasteele
authors.forename: Floor
authors.initials: F
authors.lastname: Martens
authors.forename: Michel
authors.initials: M
authors.lastname: De Pauw
mesh_terms: D000208:Acute Disease; D000328:Adult; D009202:Cardiomyopathies / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome